Women's Health September 21, 2026 0 Comments

This Common “Anxiety” Symptom in Women Is Actually Something Else—And Ignoring It Could Sabotage Your Health Journey

Ever found yourself tangled in a web of worries that don’t quite add up? Like Emily Stetzer, who spent years thinking she had generalized anxiety, only to discover it was actually obsessive-compulsive disorder (OCD) playing tricks on her mind. It’s wild how OCD can masquerade as anxiety, turning everyday fears into these intense, sometimes downright baffling obsessions that don’t just knock quietly—they slam the door. And here’s the kicker: the usual therapy that’s like a lifesaver for anxiety folks might actually make OCD worse! So, what’s really going on beneath the surface? How do you tell the subtle—and not so subtle—differences between anxiety and OCD? Dive in with me as we unpack the shadows of these mental health puzzles and explore why getting the right diagnosis isn’t just important—it’s a game changer. Ready to unravel this together? LEARN MORE

10 min read

For most of her childhood and teen years, Emily Stetzer, now 31, thought she had generalized anxiety disorder (GAD)—and to be fair, so did her parents and school guidance counselor. As a kid, she was always incredibly nervous to leave her parents for school, and would nervously confess things she considered to be “bad” about herself to her parents every night.

But her fears were always a lot more intense, and maybe even a little more random than most. When she was in college, she began to get intrusive thoughts about her sexual orientation (how did she truly know what gender she was attracted to?) and fears about contamination. She remembers being at an alleyway outside of a bar with her friends, and having to run home and shower because she touched the brick wall. When she finally went to a therapist, she was diagnosed with obsessive-compulsive disorder (OCD) at her first session.

Stetzer is one of the many people who found out they have OCD after believing for years that they had anxiety. And it makes sense: part of having OCD is experiencing feelings of anxiety, says Simone Leavell-Bruce, PsyD, a psychotherapist who specializes in OCD. Plus, because OCD thoughts can be so upsetting and taboo, many people who have the disorder won’t voice their obsessions and compulsions out loud, making it hard to get a proper diagnosis.

There’s just one major thing: A targeted diagnosis really does matter when it comes to OCD because the treatment is completely different from that of generalized anxiety. In fact, traditional talk therapy can make OCD symptoms worse. “If you don’t share with the right person that has knowledge of all these flavors of OCD, you’re just stuck alone,” says Stetzer.

Here’s how to distinguish between the two, according to experts.

Meet the experts: Simone Leavell-Bruce, PsyD, is a North Carolina-based psychotherapist who specializes in OCD. Levi Riven, PhD, is a clinical psychologist and founder of Riven Psychology.

What is OCD?

“OCD is like anxiety on steroids,” says Leavell-Bruce. “You have really horrible, intrusive thoughts and images that come in your head over and over again that just won’t stop.” In OCD, these thoughts are called obsessions—and they’re always followed by compulsions, says Levi Riven, PhD, a psychologist based in Ottawa.

The obsession is most often around some kind of doubt, and the compulsion (or ritual) exists to silence that doubt, bring comfort, and ensure certainty. Take a stereotypical example of OCD: someone might get an intrusive thought about having germs on their hands and getting sick, and engage in a compulsion of thorough handwashing to be certain that their hands are clean. (Or, like Emily, run home and take a shower when they feel like part of them might be dirty or contaminated.)

An OCD response to an obsession is usually atypical and more excessive than the average person’s response, says Leavell-Bruce. This leads to repeated interruptions of their everyday life. If a patient with health OCD has a minor toothache, they may be at the dentist the next day—or an everyday headache could land them in the waiting room at the ER, stressing about what horrible illness could be underneath their discomfort.

What OCD is Not: However many times you may have heard people say “I’m so OCD” while straightening knickknacks on their bookshelf or wiping down their counter, OCD isn’t as simple as just liking things neat and tidy—and it’s definitely not an adjective. OCD is a serious mental illness that can disrupt people’s lives, relationships, and sense of self. And contamination OCD—the kind where someone might compulsively clean or wash their hands—is just one of the many subtypes of the disorder.

About one in 40 adults in the United States has OCD, with signs most commonly appearing between the ages of 7 to 12 and in early adulthood, around age 20, per the International OCD Foundation. Women also appear to be more susceptible to the condition; one review concluded that women may be 1.6 times more likely to have OCD than men.

What Makes OCD Different From Anxiety?

Anxiety is a natural emotional byproduct of OCD, making it especially difficult to tell the difference between the two, says Riven. That being said, these four key characteristics set OCD apart.

Your obsessions are unusual to others.

While generalized anxiety disorder tends to focus on everyday fears, OCD worries—or obsessions—are more out-of-the-box, especially to those who don’t have the condition.

Take this as an example: The night before a big presentation at work, someone with anxiety might be kept up all night with racing thoughts about all the ways it could go wrong the next day. What if I fail? Did I practice enough? I hope I can pull it off. For someone with OCD, the worries are less rooted in everyday reality. Instead of being kept up by thoughts about preparedness or worrying if people will like their presentation, they might get intrusive thoughts about impulsively swearing or saying a racist slur while presenting. What if I offend people? Have I done anything like this before? Am I a bad person?

Obsessions can also often be outlandish, surprising, and taboo. Some common OCD themes revolve around worrying that you’re secretly a pedophile, getting intrusive thoughts that you’ve harmed others—or have the capability to—and confusing, all-consuming doubts around your sexuality.

That’s brings us to a core component of OCD: obsessions are usually ego-dystonic, meaning they contradict one’s value system, morals, and sense of self, says Riven. (As in: That person who is worried that they’re a pedophile is not.) Those things that people with OCD are worrying about—like harming someone—are actually the things they’d like to do least. “That’s what makes OCD so scary: it hits you with something you just don’t recognize in yourself,” says Leavell-Bruce.

Common obsessions include:

Contamination, or the extreme worry of encountering germs, diseases, or dirt that might infect you
Fear that you might harm someone, or already have but don’t know or remember doing it
Excessive worry about your health, such as having an undiagnosed condition or that you’ll acquire one
Intrusive thoughts, fears, and doubts about your sexuality and gender
Overwhelming concern over things being even, ordered, or feeling “just right”

You follow each obsession with a compulsion.

Every case of OCD will include compulsions, says Leavell-Bruce; they may just not be what you think. When most people think about OCD, they probably think about the compulsive handwashing, cleaning, or other physical rituals—but many compulsions can happen entirely inside your own head.

Instead of physical checking or seeking external reassurance, many people with OCD will go through an internal checking or rumination process to make themselves feel better, says Riven. Mental compulsions can be just as real—and overwhelming—as physical ones.

Common compulsions include:

Avoidance of a stressful stimulus or thought
Constantly asking others for reassurance
Checking that you have or have not done something
Excessively cleaning a space or yourself
Excessively ruminating about an obsession
Making sure things are “just right”
Counting
Ordering/arranging

A recent study published in Psychological Assessment that surveyed 641 OCD patients found 62 unique compulsion rituals among patients. Among this wide spectrum of physical and mental rituals, avoidance, reassurance, checking, and cleaning/handwashing were the most common.

Compulsions are also the crux of OCD treatment (more on that later). But essentially, performing—or not performing—these rituals can be the difference between reducing OCD symptoms or making them worse.

Your rumination—or deep thinking process—looks different.

Because rumination can also happen in cases of generalized anxiety disorder, it can be tough to identify it as an OCD compulsion. Rumination is when someone thinks deeply about one particular worry for a long time with the hope of better understanding it.

Someone with generalized anxiety disorder will use rumination as a way to “anticipate possible catastrophes and find ways to prevent them,” says Riven. They might weigh future choices against each other (like how much to prepare for a presentation) and stress about making the wrong decision.

Meanwhile, someone with OCD rumination compulsions will get trapped in rumination cycles where they might review and analyze memories of past actions, check their own interests and desires, or even try to cancel out “bad thoughts” with “good thoughts.” While classic anxiety rumination focuses on catastrophizing events and possibilities about the future, OCD rumination often focuses on catastrophes of the self: reassuring yourself that something did or didn’t happen, or checking your memories and emotions to ensure that certain intrusive thoughts aren’t true.

Let’s say someone with rumination OCD is worried they’ll say a slur during their work presentation. The night before, they might lie awake examining their emotions around slurs to be sure that they don’t actually want to use them and examine their memories to collect “evidence” that this behavior has never happened before. OCD rumination is all about finding proof that something did or didn’t happen, or that something about you is true or untrue.

Traditional therapy doesn’t help you feel better.

In typical cognitive behavioral therapy (CBT), a therapist will unpack a patient’s anxiety to help them understand where it comes from and to reframe the threats, says Riven. CBT talk therapy is widely considered to be the best therapy for generalized anxiety disorder treatment, per the National Institute of Mental Health. But, for someone with OCD, trying to understand a nonsensical obsession only makes things worse. If someone has an intrusive thought that they might hurt someone (a common OCD obsession), for example, there’s little benefit to trying to understand where in their personal history that thought comes from, since it’s just not based in much of anything at all. (Again, OCD thoughts tend to be against what a person actually believes and/or wants.)

“If it’s not clear that a person has OCD and they’re just expressing anxiety, a supportive and well-meaning therapist might focus on providing a lot of reassurance, which actually maintains the cycle of doubt,” says Riven. Think about it like this: Performing a compulsion like seeking and getting reassurance is almost like rewarding a dog with a treat every time they bark, says Leavell-Bruce. It’s reinforcing that whatever obsession you have is a real threat to you and deserving of attention, therefore making it stronger. Getting specialized support from a therapist trained in OCD care—who won’t provide you that reassurance—can make all the difference.

Treatments for OCD

While getting an OCD diagnosis can feel scary at first, there’s a reason for optimism: OCD is extremely treatable, says Riven. The gold-standard treatment for OCD is exposure and response prevention therapy, or ERP. There is a massive body of evidence behind ERP as the superior treatment to regular CBT for people with OCD.

While the time it takes to see results from ERP therapy differs from person to person, one recent study in BMC Psychiatry on 110 adults with OCD found a major reduction in OCD symptoms, as measured by the Yale-Brown Obsessive-Compulsive Scale, after 20 twice-weekly therapy sessions—just 10 weeks of therapy. Plus, participants’ symptoms of depression decreased and daily functioning ability increased by the end of the 20 sessions.

The whole point of ERP, Leavell-Bruce says, is to expose patients to the obsessions without engaging in compulsions. If a patient has contamination OCD, for example, she might have them touch the floor during their therapy session and then rub their hands on their face, arms, and body. When the subsequent obsession of contamination sets in, the patient has to sit in the uncomfortable uncertainty that they might have contaminated their body. Instead of reassuring the patient, or exploring the meaning behind the obsession, an ERP-trained therapist will play out the worst-case scenarios of the obsession in real time.

“Instead of saying, no, you’re not gross, I’ll say, ‘well, yeah, maybe you are gross,’” says Leavell-Bruce. Maybe that person will get a rash or throw up; there’s no way to know with 100 percent certainty. “Do we know what’s on the floor? No, we don’t. That’s the answer. When the obsession pops up, the answer is always ‘I don’t know.’”

These exposures can feel terrifying in the moment. But over time, the patient’s brain and body learn that obsessions—and uncertainty in and of itself—are not a real threat, causing their anxiety and panic to go down by itself. “It’s really powerful to see that happen in the session, and it’s even more powerful to see it happen week after week and see that their life is changed,” says Leavell-Bruce.

Allison, 25, was diagnosed with OCD last year after experiencing sudden intrusive thoughts that she had harmed other people at her job, and had to constantly ask other people for reassurance that she hadn’t done it. (She asked to be referred to by a pseudonym for this story because these intrusive thoughts are so misunderstood by the public that sharing your story—and even just your diagnosis—can feel like a real risk.)

In her ERP sessions, Allison would play out these possibilities and what would happen to her if they were true. The first sessions were brutal: she recalls sobbing in her therapist’s office as they discussed the possibility of her dying in prison. But over two months, Allison saw a complete transformation: by exploring the uncertainty, her obsessions suddenly held less power over her. Now, a year later, she says she hardly deals with OCD symptoms at all. “When obsessions come, I feel so equipped to handle them,” she says.

All that said, some people really do have comorbid anxiety and OCD, says Leavell-Bruce. One meta-analysis published in Frontiers in Psychiatry found that of a pooled sample size of 15,808 people with OCD, 69 percent had a psychiatric comorbidity. The most common were major depressive disorder, generalized anxiety disorder, and neurodevelopmental disorders. In most cases of a dual diagnosis with generalized anxiety, Leavell-Bruce finds that treating the OCD first—as the primary condition—cascades down to make the general anxiety better.

If you suspect that you have OCD, keep in mind that the only person who can diagnose and treat you is a trained clinician. “Learning that you have OCD and getting that clarification is a really important starting place for actually getting sustained relief,” says Riven.